We report on a 56-year-old patient who underwent coronary artery bypass grafting, tricuspid valve replacement, and pacemaker implantation within 49 months after heart transplantation. This case readily demonstrates that multiple cardiac procedures can be safely performed after heart transplantation and may thus serve as an alternative to retransplantation.
Objective This study aims to explore the effects of the Information-Motivation-Behavioral (IMB) Skills Model on the prevention of Venous Thromboembolism (VTE) in elderly lung cancer patients. Methods A convenience sampling method was used to select study participants who were hospitalized for treatment between November 2022 and August 2023 at a tertiary hospital in Neijiang and met the inclusion and exclusion criteria. The control group ( n = 41) received conventional health education, while the intervention group ( n = 40) received health education based on the IMB Skills Model over three months. The scores of the Venous Thrombosis Knowledge, Participation in Thrombosis Prevention Willingness and Behavior Questionnaire, and Quality of Life Measurement Scale (QLQ-C30) were compared before the intervention and after three months. After three months of intervention, the hospital satisfaction and VTE incidence rates in both groups were investigated and compared. Results After three months of intervention, the scores for the Venous Thrombosis Knowledge, (Participation in Thrombosis Prevention Willingness and Behavior Questionnaire in the intervention group were higher than those in the control group ( P < 0.05). The QLQ-C30 scores in the intervention group for physical function, role function, emotional function, insomnia, appetite loss, and overall health status were higher than those in the control group ( P < 0.05). The intervention group rated higher in doctor's professional skills, information provision, accessibility; nurse's professional skills, humanistic care, information provision, accessibility; team communication, services of other personnel, overall satisfaction compared to the control group ( P < 0.05). The rate of VTE in the intervention group was 2.5%(1/40), and that in the control group was 19.5%(8/41). There was a significant difference ( χ 2 = 4.336, P = 0.037). Conclusion Nursing interventions based on the IMB Skills Model for elderly lung cancer patients can enhance patients’ understanding of venous thrombosis, increase willingness and active participation in thrombosis prevention, improve quality of life, increase hospital satisfaction, and reduce the incidence of VTE.
Image-guided local thermal ablation (LTA) plays an important role in the treatment of hepatocellular carcinoma (HCC), especially in patients with HCC who are not suitable for hepatectomy. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most widely used LTA clinically. Radiofrequency ablation can achieve the best result; that is, a similar therapeutic effect as hepatectomy if the tumor ≤3 cm, while MWA can effectively ablate tumors ≤5 cm. Local thermal ablation has an advantage over liver resection in terms of minimally invasive surgery and can achieve a comparable prognosis and efficacy to liver resection. For borderline liver function, selecting LTA as the first-line therapy may bring more benefits to patients with cirrhosis background. In addition, a combination of multiple therapies for HCC is a good choice, such as LTA combined with transcatheter arterial chemoembolization (TACE), which can achieve a better prognosis than single therapy for larger tumors. For patients who are awaiting liver transplantation, LTA is a good choice. The main problem of LTA needed to be solved is to prevent the local tumor recurrence after ablation in patients with HCC.
Abstract Rationale: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. Patient concerns: A 28 years’ old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. Diagnosis: Emergency obstetric ultrasound scan done confirmed 32 weeks’ twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. Interventions: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks’ gestation. Outcomes: Two years’ follow-up indicated no complications and children as well as their mother are healthy. Lesions: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.
Abstract Background and Aims Pyroptosis of intestinal epithelial cells is associated with intestinal barrier dysfunction and the intestinal inflammatory symptoms of Crohn's disease (CD). The natural plant monomer, nodakenin (Nod), inhibits NOD-like receptor protein 3 (NLRP3) expression, and this study aimed to evaluate its effect on CD-like colitis, as well as possible mechanisms. Methods Using TNBS intervention mice as CD animal models, the therapeutic effect of Nod on CD-like colitis in mice was explored through disease activity index (DAI) analysis, weight change, histological analysis, inflammatory factor expression and intestinal barrier function. In addition, the direct effect of Nod on the pyroptosis of intestinal epithelial cells was explored by immunofluorescence and western blot detection in LPS-/ATP-induced colon organoid models. Furthermore, through bioinformatics and in vivo and in vitro experimental verification, the potential mechanism by which Nod protects intestinal epithelial cells was explored. Results Nod intervention improved colitis and intestinal barrier function in TNBS-induced mice, as demonstrated by improvements in weight loss, DAI, tissue inflammation score, proinflammatory factor expression, and intestinal permeability. In addition, Nod inhibited the pyroptosis of intestinal epithelial cells in colitis mice and LPS-/ATP-induced colon organoids, as well as the expression of key pyroptosis regulators, such as NLRP3, GSDMD-N, and cleaved-caspase-1. Mechanistically, Nod inhibited the activation of PI3K/Akt signalling a in intestinal epithelial cells in TNBS-induced mice and LPS-/ATP-induced colonic organoids. Conclusions Nod restrained the pyroptosis of intestinal epithelial cells to protect the intestinal barrier of CD-like colitis by inhibiting PI3K/Akt signalling, this may provide a new option for the treatment of Crohn's disease.
Hepatocellular carcinoma (HCC) remains one of the most common malignant tumors with poor survival. Pyroptosis is a kind of programmed cell death that can regulate the proliferation, invasion, and metastasis of tumor cells. However, the expression levels of pyroptosis-related genes (PRGs) in HCC and their relationship with prognosis are still unclear.Our study identified 35 PRGs through bioinformatics analysis that were differentially expressed between tumor samples and nontumor samples. According to these differentially expressed genes, HCC patients could be divided into two groups, cluster 1 and cluster 2. The least absolute shrinkage and selection operator (LASSO) Cox regression method was performed to construct a 10-gene signature that classified HCC patients in the cancer genome atlas (TCGA) database into low-risk and high-risk groups.The results showed that the survival rate of HCC patients in the low-risk group was significantly higher than that in the high-risk group (p < 0.001). The validation cohort, the Gene Expression Omnibus (GEO) cohort, was divided into two risk groups based on the median risk score calculated by the TCGA cohort. The overall survival (OS) of the low-risk group was significantly better than that of the high-risk group (p = 0.007). Univariate and multivariate Cox regression analyses revealed that the risk score was an independent factor in predicting OS in HCC patients. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses showed that immune-related high-risk groups were rich in genes and had reduced immune status.PRGs play a significant role in tumor immunity and have the potential capability to predict the prognosis of HCC patients.
Aliment Pharmacol Ther 2010; 32: 925–933 Summary Background Although it is recognized that diarrhoea commonly complicates enteral nutrition, the causes remain unknown. Aim To identify factors associated with diarrhoea in patients receiving enteral nutrition with specific attention to formula composition. Methods Medical histories of in‐patients receiving enteral nutrition were identified by ICD‐10‐AM coding and randomly selected from the year 2003 to 2008. Clinical and demographic data were extracted. Formulas were classified according to osmolality, fibre and FODMAP (fermentable oligo‐, di‐ and mono‐saccharides and polyols) content. Results Formula FODMAP levels ranged from 10.6 to 36.5 g/day. Of 160 patients receiving enteral nutrition, 61% had diarrhoea. Univariate analysis showed diarrhoea was associated with length of stay >21 days (OR 4.2), enteral nutrition duration >11 days (OR 4.0) and antibiotic use (OR 2.1). After adjusting for influencing variables through a logistic regression model, a greater than five‐fold reduction in risk of developing diarrhoea was seen in patients initiated on Isosource 1.5 ( P = 0.029; estimated OR 0.18). The only characteristic unique to this formula was its FODMAP content, being 47–71% lower than any other formula. Conclusions Length of stay and enteral nutrition duration independently predicted diarrhoea development, while being initiated on a lower FODMAP formula reduced the likelihood of diarrhoea. As retrospective evaluation does not support a cause–effect relationship, an interventional study investigating FODMAPs in enteral formula is indicated.
Abstract Background Lack of opportunity for radical surgery and postoperative tumor recurrence are challenges for surgeons and hepatocellular carcinoma (HCC) patients. This study aimed to develop nomograms to predict recurrence risk and recurrence-free survival (RFS) probability after conversion hepatectomy for patients previously receiving transarterial interventional therapy. Methods In total, 261 HCC patients who underwent conversion liver resection and previously received transarterial interventional therapy were retrospectively enrolled. Nomograms to predict recurrence risk and RFS were developed, with discriminative ability and calibration evaluated by C-statistics, calibration plots, and the Area under the Receiver Operator Characteristic (AUROC) curves. Results Univariate/multivariable logistic regression and Cox regression analyses were used to identify predictive factors for recurrence risk and RFS, respectively. The following factors were selected as predictive of recurrence: age, tumor number, microvascular invasion (MVI) grade, preoperative alpha‐fetoprotein (AFP), preoperative carbohydrate antigen 19-9 (CA19-9), and Eastern Cooperative Oncology Group performance score (ECOG PS). Similarly, age, tumor number, postoperative AFP, postoperative protein induced by vitamin K absence or antagonist-II (PIVKA-II), and ECOG PS were incorporated for the prediction of RFS. The discriminative ability and calibration of the nomograms revealed good predictive ability. Calibration plots showed good agreement between the nomogram predictions of recurrence and RFS and the actual observations. Conclusions A pair of reliable nomograms was developed to predict recurrence and RFS in HCC patients after conversion resection who previously received transarterial interventional therapy. These predictive models can be used as guidance for clinicians to help with treatment strategies.
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